Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

Abstract

Patients with multiple sclerosis (PwMS) have a high level of fatigue and a reduced quality of life (QoL) due to the impact of multiple sclerosis (MS). Virtual reality-based therapy (VRBT) is being used to reduce disability in PwMS. The aim of this study was to assess the effect of VRBT on fatigue, the impact of MS, and QoL in PwMS. Methods: A systematic review with meta-analysis was conducted through a bibliographic search on PubMed, Scopus, Web of Science, and PEDro up to April 2021. We included randomized controlled trials (RCTs) with PwMS that received VRBT in comparison to conventional therapy (CT) including physiotherapy, balance and strength exercises, and stretching or physical activity, among others; or in comparison to simple observation; in order to assess fatigue, MS-impact, and QoL. The effect size was calculated using Cohen’s standardized mean difference with a 95% confidence interval (95% CI). Results: Twelve RCTs that provided data from 606 PwMS (42.83 ± 6.86 years old and 70% women) were included. The methodological quality mean, according to the PEDro Scale, was 5.83 ± 0.83 points. Our global findings showed that VRBT is effective at reducing fatigue (SMD −0.33; 95% CI −0.61, −0.06), lowering the impact of MS (SMD −0.3; 95% CI −0.55, −0.04), and increasing overall QoL (0.5; 95% CI 0.23, 0.76). Subgroup analysis showed the following: (1) VRBT is better than CT at reducing fatigue (SMD −0.4; 95% CI −0.7, −0.11), as well as in improving the mental dimension of QoL (SMD 0.51; 95% CI 0.02, 1); (2) VRBT is better than simple observation at reducing the impact of MS (SMD −0.61; 95% CI −0.97, −0.23) and increasing overall QoL (SMD 0.79; 95% CI 0.3, 1.28); and (3) when combined with CT, VRBT is more effective than CT in improving the global (SMD 0.6, 95% CI 0.13, 1.07), physical (SMD 0.87; 95% CI 0.3, 1.43), and mental dimensions (SMD 0.6; 95% CI 0.08, 1.11) of QoL. Conclusion: VRBT is effective at reducing fatigue and MS impact and improving QoL in PwMS.

Virtual Reality Rehabilitation Systems for Cancer Survivors: A Narrative Review of the Literature

“…Two of the included studies found statistically significant effects of VR on cancer-related fatigue. This is consistent with the previous literature, which found VRR effective for the treatment of chronic fatigue in other conditions, such as multiple sclerosis [60]. Regarding specifically cancer-related fatigue, however, the previous studies have focused on testing the effects of VR on acute cancer fatigue, for example during procedures such as chemotherapy infusions.…”

Breathlessness and exercise with virtual reality system in long-post-coronavirus disease 2019 patients

“…Moreover, dyspnea activates a network of sensorimotor, cerebellar, limbic, and emotion-related areas (30). Exercise with VR systems is often used in neurorehabilitation therapies (patients with multiple sclerosis) and can lead to reduced levels of fatigue (31). In addition, exercising in a VR environment can lead to reduced feelings of pain and fatigue, such as in patients with spinal cord injury, compared with exercising in a no-VR environment (32).…”

Effect of immersive virtual reality training on hand-to-mouth task performance in people with Multiple Sclerosis: A quantitative kinematic study

“…A series of recent reviews which summarized the results of the studies carried out in the last 15 years, pointed out that VR-based training has a positive effect in PwMS as regards fatigue, quality of life and postural control, at least equal to, or greater than, conventional exercise (Cortés-Pérez et al, 2021;Nascimiento et al, 2021). However, it is noteworthy that most of the screened interventions targeted balance, gait or other lower limb function outcomes, while the use of this approach to improve UL function appears to have been explored less.…”